MedicaidCoverageHigh impact
BT2024126: IHCP announces expanded coverage of biomarker testing
Indiana Medicaid (IHCP)·IN · Oncology, Hematology, Pathology +2 more·Medical Policy
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP/Medicaid) has expanded coverage for biomarker testing effective July 1, 2024, adding over 100 new CPT codes for genetic and molecular pathology tests. Many of these newly covered codes require prior authorization, and tests must meet specific FDA or clinical guideline criteria.
Action Required
Immediately: Billing team must update Indiana Medicaid billing system to recognize newly covered biomarker testing codes effective July 1, 2024. Configure prior authorization requirements for specified codes (approximately 60% require PA - see Table 1). Ensure tests meet coverage criteria including FDA approval or nationally recognized clinical guidelines. Verify codes exist on Medicare fee schedule before billing. Update encounter forms to alert providers of PA requirements for genetic testing orders.